{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,9,26]],"date-time":"2025-09-26T08:30:49Z","timestamp":1758875449555,"version":"3.40.5"},"reference-count":42,"publisher":"Wiley","issue":"11","license":[{"start":{"date-parts":[[2020,9,17]],"date-time":"2020-09-17T00:00:00Z","timestamp":1600300800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J of Clinical Hypertension"],"published-print":{"date-parts":[[2020,11]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>Clinic blood pressure (BP) measurement remains a crucial step in managing hypertension. While the number of measures recorded in different settings varies, with typically 1\u20103 measures, there has been no prior justification for the actual number of measures required. We investigated the pattern of BP variability over 5 consecutive automated readings (R1\u2010R5) and the influence of patient characteristics on this pattern to identify the phenotype of hypertension in a Middle Eastern population. There were 1389 outpatients (51% men, 49% women), age range (18\u201087 y) who had 5 unattended automated consecutive BP measurements with one\u2010minute intervals using the validated Datascope Mindray Passport V Monitor with the patient blinded from the results. Mean (\u00b1SEM) SBP for R1 (136.0\u00a0\u00b1\u00a02\u00a0mm Hg) was similar to R2 (136.2\u00a0\u00b1\u00a02\u00a0mm Hg). Thereafter SBP progressively declined till R5 by total of 5.5\u00a0mm Hg. The SBP decline was less (4.2\u00a0mm Hg) in older (&gt;50\u00a0years) vs younger participants (8.1\u00a0mm Hg; <jats:italic>P<\/jats:italic>\u00a0&lt;\u00a0.001) and was blunted in diabetic and hypertensive participants. Overall, 43% of participants had R2\u00a0&gt;\u00a0R1, and 24% additionally had R5\u00a0&gt;\u00a0R1. Age was a strong independent predictor of having both R2\u00a0&gt;\u00a0R1 and R5\u00a0&gt;\u00a0R1, as well as diabetes. Diastolic blood pressure (DBP) decreased by average 2.8\u00a0mm Hg from R1 to R5. Females had a 5\u2010fold greater total decline in DBP vs males (<jats:italic>P<\/jats:italic>\u00a0&lt;\u00a0.001). Using the mean of 5 BP measures resulted in fewer participants being classified as hypertensive (36% of the population) compared to using one measurement (46%), or established BP guidelines which use different combinations of R1\u2010R3 (37%\u201042%). Our findings in a Middle Eastern population highlight the importance of the BP measurement protocol in combination with patient characteristics in determining whether a patient is diagnosed with hypertension. Protocols that rely on different combinations of only 3 measures (R1\u20103) will classify more participants as hypertensive, compared to using 5 measures or disregarding a high R2.<\/jats:p>","DOI":"10.1111\/jch.14048","type":"journal-article","created":{"date-parts":[[2020,9,17]],"date-time":"2020-09-17T20:10:16Z","timestamp":1600373416000},"page":"1995-2003","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Blood pressure measurement protocol determines hypertension phenotypes in a Middle Eastern population"],"prefix":"10.1111","volume":"22","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9079-7070","authenticated-orcid":false,"given":"Hazem M.","family":"Warda","sequence":"first","affiliation":[{"name":"Alhyatt Heart and Vascular Center Alexandria Egypt"},{"name":"Department of Cardiology Faculty of Medicine Tanta University Hospital Tanta Egypt"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Amany K.","family":"Elshorbagy","sequence":"additional","affiliation":[{"name":"Department of Physiology Faculty of Medicine University of Alexandria Alexandria Egypt"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1955-1203","authenticated-orcid":false,"given":"Amira","family":"Habib","sequence":"additional","affiliation":[{"name":"Alhyatt Heart and Vascular Center Alexandria Egypt"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ahmed","family":"Wagdi","sequence":"additional","affiliation":[{"name":"Alhyatt Heart and Vascular Center Alexandria Egypt"},{"name":"Institute of Cardiovascular Physiology University Medical Center Goettingen Goettingen Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anastasia S.","family":"Mihailidou","sequence":"additional","affiliation":[{"name":"Department of Cardiology and Kolling Institute Royal North Shore Hospital St Leonards NSW Australia"},{"name":"Faculty of Medicine and Health Sciences Macquarie University Sydney NSW Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mamdouh","family":"Warda","sequence":"additional","affiliation":[{"name":"Alhyatt Heart and Vascular Center Alexandria Egypt"},{"name":"Department of Cardiology Faculty of Medicine Tanta University Hospital Tanta Egypt"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2020,9,17]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1097\/HJH.0b013e3283625055"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1161\/HYP.0000000000000003"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2013.11.007"},{"issue":"12","key":"e_1_2_9_5_1","doi-asserted-by":"crossref","first-page":"2463","DOI":"10.1097\/HJH.0000000000000005","article-title":"New blood pressure control goals, more rational but facilitating therapeutic inertia?","volume":"31","author":"Mancia G","year":"2013","journal-title":"J Hypertens"},{"key":"e_1_2_9_6_1","unstructured":"JonesDW LenfantC AppelLJ et al.Working meeting on blood pressure measurement. 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